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Cardiac surgeons at Birmingham hospital must submit weekly mortality data after higher than expected deaths

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1339 (Published 04 March 2016) Cite this as: BMJ 2016;352:i1339
  1. Nigel Hawkes
  1. London

Queen Elizabeth Hospital Birmingham has been told to submit weekly returns on its cardiac surgery mortality after more patients died there than would have been expected.

Data published on the website of the Society for Cardiothoracic Surgery show that in the period 2011 to 2014 a total of 1713 heart operations were conducted at the hospital, with a survival rate of 95.45%, after adjustment for the difficulty of each operation. This is significantly worse than the average rate for all units in England, by a margin large enough to set alarm bells ringing.

The Care Quality Commission visited the hospital before Christmas, the Guardian newspaper reported,1 and considered closing down the unit. Instead it decided to order weekly data to be submitted. Mike Richards, chief inspector of hospitals, told the newspaper that the CQC’s report would be published shortly. “We have told the trust to take immediate action and have been monitoring individual patient safety and outcome data on a weekly basis,” he said.

University Hospitals Birmingham NHS Foundation Trust, which runs the hospital, said that it had been aware of a cluster of deaths between September 2011 and September 2012, relating to one surgeon. This surgeon, Ian Wilson, was suspended and subsequently dismissed.2 3

In October 2014 an inquest in Birmingham into the deaths of three patients operated on by Wilson found he had deviated from acceptable practice. An internal investigation by the hospital found that Wilson had exaggerated his patients’ comorbidities, such as unstable angina or high blood pressure, which had made his mortality rate lower once comorbidities were accounted for. Wilson is currently facing an inquiry by the General Medical Council.

The hospital’s statement said that in July 2015, after a review of internal data and two months before the data were published, some of its cardiac consultant surgeons had met the medical director to establish a quality improvement programme in recognition of changes that needed to be made to the cardiac surgery service.

“Our outcomes were already improving at the time and have continued to improve under the programme” the statement said. “None of the cardiac surgeons currently working at UHB [University Hospitals Birmingham] are outliers for mortality outcomes.”

The trust has claimed, in comments to the Guardian, that it did not believe that the published figures did it justice. They include the Ian Wilson figures but exclude data from operations carried out by its surgeons at the private Priory Hospital for the NHS, which recorded no deaths in 130 operations.

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